Posterior Radical Antegrade Modular Pancreatosplenectomy (RAMPS) Improved the Prognosis of Pancreatic Body Adenocarcinoma: A Retrospective Cohort Study Using Propensity Score Matching

Abstract

Abstract BACKGROUND Posterior radical antegrade modular pancreatosplenectomy (RAMPS) involves a more extensive resection than anterior RAMPS for adenocarcinoma of pancreatic body and tail, but the benefit is not confirmed. This study sought to compare the perioperative surgical and long-term survival outcomes between the two groups. METHODS This retrospective study included 354 patients who underwent RAMPS for treatment of pancreatic body and tail cancer. Propensity score matching (PSM) and sub-group analysis was carried out to compare the perioperative and long-term survival outcomes between the groups. RESULTS This study included 201 patients who underwent anterior and 153 patients posterior RAMPS. Posterior RAMPS resulted in significantly more intraoperative bleeding and dissected lymph nodes, but no significant difference in complication rates. The survival outcomes were not significantly different between the two operations in the whole dataset. In the pancreatic body subgroup, PSM analysis showed posterior RAMPS significantly prolonged overall survival time (Median OS: 25.5 months vs. 18.6 months, P = 0.047) and disease free survival time (Median DFS: 16.2 months vs. 11.9 months, P = 0.032) compared with anterior RAMPS, but the benefit was not obvious in the pancreatic tail subgroup. And posterior RAMPS was an independent factor of OS in the pancreatic body subgroup with no increased complications. DISCUSSION Posterior RAMPS could safely be performed in high-volume centers without increase in complications. And posterior RAMPS should be considered for pancreatic body adenocarcinoma to improve the prognosis rather than pancreatic tail.